They run a general outpatient clinic
called GOPD (General Out Patient Department). It is manned mainly by
interns, and probably by resident doctors of preventive and social
medicine. It is like the general practice of doctors who go into
private practice after obtaining their M.B.B.S. degree and practice
family medicine. Clinical examination is often cursory and
prescriptions are based solely on the patients’ symptoms. It is not
supposed to be so, neither in GOPD nor in family practice. But many
interns do not realize this, I suppose. How they change when they
start family practice is beyond my comprehension.
One patient was referred to my
outpatient clinic from GOPD for genital prolapse. She had gone to
GOPD with breathlessness and prolapse. I looked at her case paper.
There were no examination findings. She had been given iron, calcium
and multivitamin tablets at the first visit to the GOPD. She had not
improved. At the next visit she had received the same medicines, plus
tablet salbutamol. She had not improved with that too. I checked her
up. She had uterovaginal prolapse. Her respiratory and cardiovascular
systems were normal. There was no bronchospasm. I advised her
appropriate tests and made a medical reference for her
breathlessness. Finally it turned out to be just old age and poor
stamina, and having to keep working to survive. We treated her
prolapse and she went away happy.
That intern who prescribed asthma
medicine without clinical evidence of any bronchospasm reminded me of
a student who was in my class. The fellow was supposed to be
reasonably bright. When we were posted at an urban slum as interns,
he prescribed aspirin tablets to one patient in a dose of 2 tablets
four times a day. I was running the dispensary. I dispensed 1 tablet
three times a day and went looking for him.
“Why did you prescribe such a large
dose?” I asked him.
“The patient said he had ‘verrrry’
severe pain” he said, drawing out the word ‘very’ to indicate a
very high degree of ‘very’.
“If the patient had said he had
‘verrrrrrrry’ severe pain, would you have prescribed 4 tablets
four times a day?” I asked him. I hear he went to UK to do FRCS,
came back to India to try his hand on patients, was dissatisfied by
the lukewarm response, went to US and did MS to settle down there. I
wonder if he still holds a grudge against me for asking that
question.
